|
CALCITRIOL 0.25MCG CAPSULE
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 62756096783
|
| Hospital Charge Code |
3007212
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna Commercial |
$7.60
|
| Rate for Payer: Aetna Medicare |
$7.20
|
| Rate for Payer: BCBS MT CHIP |
$7.20
|
| Rate for Payer: BCBS MT Closed Plan Network |
$7.60
|
| Rate for Payer: BCBS MT HealthLink |
$7.20
|
| Rate for Payer: BCBS MT Medicare |
$7.20
|
| Rate for Payer: BCBS MT POS |
$7.60
|
| Rate for Payer: BCBS MT Traditional |
$8.00
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$7.60
|
| Rate for Payer: Cigna Medicare |
$7.20
|
| Rate for Payer: Medicaid All Medicaid |
$7.36
|
| Rate for Payer: Medicare All Medicare |
$5.60
|
| Rate for Payer: Monida Allegiance |
$7.60
|
| Rate for Payer: Monida First Choice Health |
$7.76
|
| Rate for Payer: Monida Montana Health Co-op |
$7.60
|
| Rate for Payer: Monida PacificSource |
$7.60
|
|
|
CALCITRIOL 0.25MCG CAPSULE
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 62756096783
|
| Hospital Charge Code |
3007212
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna Commercial |
$7.60
|
| Rate for Payer: Aetna Medicare |
$7.20
|
| Rate for Payer: BCBS MT CHIP |
$7.20
|
| Rate for Payer: BCBS MT Closed Plan Network |
$7.60
|
| Rate for Payer: BCBS MT HealthLink |
$7.20
|
| Rate for Payer: BCBS MT Medicare |
$7.20
|
| Rate for Payer: BCBS MT POS |
$7.60
|
| Rate for Payer: BCBS MT Traditional |
$8.00
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$7.60
|
| Rate for Payer: Cigna Medicare |
$7.20
|
| Rate for Payer: Medicaid All Medicaid |
$7.36
|
| Rate for Payer: Medicare All Medicare |
$5.60
|
| Rate for Payer: Monida Allegiance |
$7.60
|
| Rate for Payer: Monida First Choice Health |
$7.76
|
| Rate for Payer: Monida Montana Health Co-op |
$7.60
|
| Rate for Payer: Monida PacificSource |
$7.60
|
|
|
CALCIUM, 24 HOUR URINE (003269)
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
HCPCS 82340
|
| Hospital Charge Code |
4082340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Aetna Commercial |
$56.05
|
| Rate for Payer: Aetna Medicare |
$53.10
|
| Rate for Payer: BCBS MT CHIP |
$53.10
|
| Rate for Payer: BCBS MT Closed Plan Network |
$56.05
|
| Rate for Payer: BCBS MT HealthLink |
$53.10
|
| Rate for Payer: BCBS MT Medicare |
$53.10
|
| Rate for Payer: BCBS MT POS |
$56.05
|
| Rate for Payer: BCBS MT Traditional |
$59.00
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$56.05
|
| Rate for Payer: Cigna Medicare |
$53.10
|
| Rate for Payer: Medicaid All Medicaid |
$54.28
|
| Rate for Payer: Medicare All Medicare |
$41.30
|
| Rate for Payer: Monida Allegiance |
$56.05
|
| Rate for Payer: Monida First Choice Health |
$57.23
|
| Rate for Payer: Monida Montana Health Co-op |
$56.05
|
| Rate for Payer: Monida PacificSource |
$56.05
|
|
|
CALCIUM, 24 HOUR URINE (003269)
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS 82340
|
| Hospital Charge Code |
4082340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Aetna Commercial |
$56.05
|
| Rate for Payer: Aetna Medicare |
$53.10
|
| Rate for Payer: BCBS MT CHIP |
$53.10
|
| Rate for Payer: BCBS MT Closed Plan Network |
$56.05
|
| Rate for Payer: BCBS MT HealthLink |
$53.10
|
| Rate for Payer: BCBS MT Medicare |
$53.10
|
| Rate for Payer: BCBS MT POS |
$56.05
|
| Rate for Payer: BCBS MT Traditional |
$59.00
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$56.05
|
| Rate for Payer: Cigna Medicare |
$53.10
|
| Rate for Payer: Medicaid All Medicaid |
$54.28
|
| Rate for Payer: Medicare All Medicare |
$41.30
|
| Rate for Payer: Monida Allegiance |
$56.05
|
| Rate for Payer: Monida First Choice Health |
$57.23
|
| Rate for Payer: Monida Montana Health Co-op |
$56.05
|
| Rate for Payer: Monida PacificSource |
$56.05
|
|
|
CALCIUM CARB CHEW TAB [500 MG]
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
3000065
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Aetna Commercial |
$4.75
|
| Rate for Payer: Aetna Medicare |
$4.50
|
| Rate for Payer: BCBS MT CHIP |
$4.50
|
| Rate for Payer: BCBS MT Closed Plan Network |
$4.75
|
| Rate for Payer: BCBS MT HealthLink |
$4.50
|
| Rate for Payer: BCBS MT Medicare |
$4.50
|
| Rate for Payer: BCBS MT POS |
$4.75
|
| Rate for Payer: BCBS MT Traditional |
$5.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna Commercial |
$4.75
|
| Rate for Payer: Cigna Medicare |
$4.50
|
| Rate for Payer: Medicaid All Medicaid |
$4.60
|
| Rate for Payer: Medicare All Medicare |
$3.50
|
| Rate for Payer: Monida Allegiance |
$4.75
|
| Rate for Payer: Monida First Choice Health |
$4.85
|
| Rate for Payer: Monida Montana Health Co-op |
$4.75
|
| Rate for Payer: Monida PacificSource |
$4.75
|
|
|
CALCIUM CARB CHEW TAB [500 MG]
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
3000065
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Aetna Commercial |
$4.75
|
| Rate for Payer: Aetna Medicare |
$4.50
|
| Rate for Payer: BCBS MT CHIP |
$4.50
|
| Rate for Payer: BCBS MT Closed Plan Network |
$4.75
|
| Rate for Payer: BCBS MT HealthLink |
$4.50
|
| Rate for Payer: BCBS MT Medicare |
$4.50
|
| Rate for Payer: BCBS MT POS |
$4.75
|
| Rate for Payer: BCBS MT Traditional |
$5.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna Commercial |
$4.75
|
| Rate for Payer: Cigna Medicare |
$4.50
|
| Rate for Payer: Medicaid All Medicaid |
$4.60
|
| Rate for Payer: Medicare All Medicare |
$3.50
|
| Rate for Payer: Monida Allegiance |
$4.75
|
| Rate for Payer: Monida First Choice Health |
$4.85
|
| Rate for Payer: Monida Montana Health Co-op |
$4.75
|
| Rate for Payer: Monida PacificSource |
$4.75
|
|
|
CALCIUM CHLORIDE 10% INJ [10 ML]
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
3000066
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Aetna Commercial |
$38.95
|
| Rate for Payer: Aetna Medicare |
$36.90
|
| Rate for Payer: BCBS MT CHIP |
$36.90
|
| Rate for Payer: BCBS MT Closed Plan Network |
$38.95
|
| Rate for Payer: BCBS MT HealthLink |
$36.90
|
| Rate for Payer: BCBS MT Medicare |
$36.90
|
| Rate for Payer: BCBS MT POS |
$38.95
|
| Rate for Payer: BCBS MT Traditional |
$41.00
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$38.95
|
| Rate for Payer: Cigna Medicare |
$36.90
|
| Rate for Payer: Medicaid All Medicaid |
$37.72
|
| Rate for Payer: Medicare All Medicare |
$28.70
|
| Rate for Payer: Monida Allegiance |
$38.95
|
| Rate for Payer: Monida First Choice Health |
$39.77
|
| Rate for Payer: Monida Montana Health Co-op |
$38.95
|
| Rate for Payer: Monida PacificSource |
$38.95
|
|
|
CALCIUM CHLORIDE 10% INJ [10 ML]
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
3000066
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Aetna Commercial |
$38.95
|
| Rate for Payer: Aetna Medicare |
$36.90
|
| Rate for Payer: BCBS MT CHIP |
$36.90
|
| Rate for Payer: BCBS MT Closed Plan Network |
$38.95
|
| Rate for Payer: BCBS MT HealthLink |
$36.90
|
| Rate for Payer: BCBS MT Medicare |
$36.90
|
| Rate for Payer: BCBS MT POS |
$38.95
|
| Rate for Payer: BCBS MT Traditional |
$41.00
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$38.95
|
| Rate for Payer: Cigna Medicare |
$36.90
|
| Rate for Payer: Medicaid All Medicaid |
$37.72
|
| Rate for Payer: Medicare All Medicare |
$28.70
|
| Rate for Payer: Monida Allegiance |
$38.95
|
| Rate for Payer: Monida First Choice Health |
$39.77
|
| Rate for Payer: Monida Montana Health Co-op |
$38.95
|
| Rate for Payer: Monida PacificSource |
$38.95
|
|
|
CALCIUM, IONIZED
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 82330
|
| Hospital Charge Code |
4082330
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$131.00 |
| Rate for Payer: Aetna Commercial |
$124.45
|
| Rate for Payer: Aetna Medicare |
$117.90
|
| Rate for Payer: BCBS MT CHIP |
$117.90
|
| Rate for Payer: BCBS MT Closed Plan Network |
$124.45
|
| Rate for Payer: BCBS MT HealthLink |
$117.90
|
| Rate for Payer: BCBS MT Medicare |
$117.90
|
| Rate for Payer: BCBS MT POS |
$124.45
|
| Rate for Payer: BCBS MT Traditional |
$131.00
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna Commercial |
$124.45
|
| Rate for Payer: Cigna Medicare |
$117.90
|
| Rate for Payer: Medicaid All Medicaid |
$120.52
|
| Rate for Payer: Medicare All Medicare |
$91.70
|
| Rate for Payer: Monida Allegiance |
$124.45
|
| Rate for Payer: Monida First Choice Health |
$127.07
|
| Rate for Payer: Monida Montana Health Co-op |
$124.45
|
| Rate for Payer: Monida PacificSource |
$124.45
|
|
|
CALCIUM, IONIZED
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 82330
|
| Hospital Charge Code |
4082330
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$131.00 |
| Rate for Payer: Aetna Commercial |
$124.45
|
| Rate for Payer: Aetna Medicare |
$117.90
|
| Rate for Payer: BCBS MT CHIP |
$117.90
|
| Rate for Payer: BCBS MT Closed Plan Network |
$124.45
|
| Rate for Payer: BCBS MT HealthLink |
$117.90
|
| Rate for Payer: BCBS MT Medicare |
$117.90
|
| Rate for Payer: BCBS MT POS |
$124.45
|
| Rate for Payer: BCBS MT Traditional |
$131.00
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna Commercial |
$124.45
|
| Rate for Payer: Cigna Medicare |
$117.90
|
| Rate for Payer: Medicaid All Medicaid |
$120.52
|
| Rate for Payer: Medicare All Medicare |
$91.70
|
| Rate for Payer: Monida Allegiance |
$124.45
|
| Rate for Payer: Monida First Choice Health |
$127.07
|
| Rate for Payer: Monida Montana Health Co-op |
$124.45
|
| Rate for Payer: Monida PacificSource |
$124.45
|
|
|
CALCIUM, TOTAL
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
HCPCS 82310
|
| Hospital Charge Code |
4082310
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: Aetna Commercial |
$58.90
|
| Rate for Payer: Aetna Medicare |
$55.80
|
| Rate for Payer: BCBS MT CHIP |
$55.80
|
| Rate for Payer: BCBS MT Closed Plan Network |
$58.90
|
| Rate for Payer: BCBS MT HealthLink |
$55.80
|
| Rate for Payer: BCBS MT Medicare |
$55.80
|
| Rate for Payer: BCBS MT POS |
$58.90
|
| Rate for Payer: BCBS MT Traditional |
$62.00
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$58.90
|
| Rate for Payer: Cigna Medicare |
$55.80
|
| Rate for Payer: Medicaid All Medicaid |
$57.04
|
| Rate for Payer: Medicare All Medicare |
$43.40
|
| Rate for Payer: Monida Allegiance |
$58.90
|
| Rate for Payer: Monida First Choice Health |
$60.14
|
| Rate for Payer: Monida Montana Health Co-op |
$58.90
|
| Rate for Payer: Monida PacificSource |
$58.90
|
|
|
CALCIUM, TOTAL
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
HCPCS 82310
|
| Hospital Charge Code |
4082310
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: Aetna Commercial |
$58.90
|
| Rate for Payer: Aetna Medicare |
$55.80
|
| Rate for Payer: BCBS MT CHIP |
$55.80
|
| Rate for Payer: BCBS MT Closed Plan Network |
$58.90
|
| Rate for Payer: BCBS MT HealthLink |
$55.80
|
| Rate for Payer: BCBS MT Medicare |
$55.80
|
| Rate for Payer: BCBS MT POS |
$58.90
|
| Rate for Payer: BCBS MT Traditional |
$62.00
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$58.90
|
| Rate for Payer: Cigna Medicare |
$55.80
|
| Rate for Payer: Medicaid All Medicaid |
$57.04
|
| Rate for Payer: Medicare All Medicare |
$43.40
|
| Rate for Payer: Monida Allegiance |
$58.90
|
| Rate for Payer: Monida First Choice Health |
$60.14
|
| Rate for Payer: Monida Montana Health Co-op |
$58.90
|
| Rate for Payer: Monida PacificSource |
$58.90
|
|
|
CALCIUM/VITAMIN D3 TAB [600 MG/400 IU]
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
3000067
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Aetna Commercial |
$4.75
|
| Rate for Payer: Aetna Medicare |
$4.50
|
| Rate for Payer: BCBS MT CHIP |
$4.50
|
| Rate for Payer: BCBS MT Closed Plan Network |
$4.75
|
| Rate for Payer: BCBS MT HealthLink |
$4.50
|
| Rate for Payer: BCBS MT Medicare |
$4.50
|
| Rate for Payer: BCBS MT POS |
$4.75
|
| Rate for Payer: BCBS MT Traditional |
$5.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna Commercial |
$4.75
|
| Rate for Payer: Cigna Medicare |
$4.50
|
| Rate for Payer: Medicaid All Medicaid |
$4.60
|
| Rate for Payer: Medicare All Medicare |
$3.50
|
| Rate for Payer: Monida Allegiance |
$4.75
|
| Rate for Payer: Monida First Choice Health |
$4.85
|
| Rate for Payer: Monida Montana Health Co-op |
$4.75
|
| Rate for Payer: Monida PacificSource |
$4.75
|
|
|
CALCIUM/VITAMIN D3 TAB [600 MG/400 IU]
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
3000067
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Aetna Commercial |
$4.75
|
| Rate for Payer: Aetna Medicare |
$4.50
|
| Rate for Payer: BCBS MT CHIP |
$4.50
|
| Rate for Payer: BCBS MT Closed Plan Network |
$4.75
|
| Rate for Payer: BCBS MT HealthLink |
$4.50
|
| Rate for Payer: BCBS MT Medicare |
$4.50
|
| Rate for Payer: BCBS MT POS |
$4.75
|
| Rate for Payer: BCBS MT Traditional |
$5.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna Commercial |
$4.75
|
| Rate for Payer: Cigna Medicare |
$4.50
|
| Rate for Payer: Medicaid All Medicaid |
$4.60
|
| Rate for Payer: Medicare All Medicare |
$3.50
|
| Rate for Payer: Monida Allegiance |
$4.75
|
| Rate for Payer: Monida First Choice Health |
$4.85
|
| Rate for Payer: Monida Montana Health Co-op |
$4.75
|
| Rate for Payer: Monida PacificSource |
$4.75
|
|
|
CALIBRATOR,AMMONIA
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
90197093
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial |
$33.25
|
| Rate for Payer: Aetna Medicare |
$31.50
|
| Rate for Payer: BCBS MT CHIP |
$31.50
|
| Rate for Payer: BCBS MT Closed Plan Network |
$33.25
|
| Rate for Payer: BCBS MT HealthLink |
$31.50
|
| Rate for Payer: BCBS MT Medicare |
$31.50
|
| Rate for Payer: BCBS MT POS |
$33.25
|
| Rate for Payer: BCBS MT Traditional |
$35.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$33.25
|
| Rate for Payer: Cigna Medicare |
$31.50
|
| Rate for Payer: Medicaid All Medicaid |
$32.20
|
| Rate for Payer: Medicare All Medicare |
$24.50
|
| Rate for Payer: Monida Allegiance |
$33.25
|
| Rate for Payer: Monida First Choice Health |
$33.95
|
| Rate for Payer: Monida Montana Health Co-op |
$33.25
|
| Rate for Payer: Monida PacificSource |
$33.25
|
|
|
CALIBRATOR,AMMONIA
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
90197093
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial |
$33.25
|
| Rate for Payer: Aetna Medicare |
$31.50
|
| Rate for Payer: BCBS MT CHIP |
$31.50
|
| Rate for Payer: BCBS MT Closed Plan Network |
$33.25
|
| Rate for Payer: BCBS MT HealthLink |
$31.50
|
| Rate for Payer: BCBS MT Medicare |
$31.50
|
| Rate for Payer: BCBS MT POS |
$33.25
|
| Rate for Payer: BCBS MT Traditional |
$35.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$33.25
|
| Rate for Payer: Cigna Medicare |
$31.50
|
| Rate for Payer: Medicaid All Medicaid |
$32.20
|
| Rate for Payer: Medicare All Medicare |
$24.50
|
| Rate for Payer: Monida Allegiance |
$33.25
|
| Rate for Payer: Monida First Choice Health |
$33.95
|
| Rate for Payer: Monida Montana Health Co-op |
$33.25
|
| Rate for Payer: Monida PacificSource |
$33.25
|
|
|
CALIBRATOR, ANEMIA
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
90197099
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna Commercial |
$66.50
|
| Rate for Payer: Aetna Medicare |
$63.00
|
| Rate for Payer: BCBS MT CHIP |
$63.00
|
| Rate for Payer: BCBS MT Closed Plan Network |
$66.50
|
| Rate for Payer: BCBS MT HealthLink |
$63.00
|
| Rate for Payer: BCBS MT Medicare |
$63.00
|
| Rate for Payer: BCBS MT POS |
$66.50
|
| Rate for Payer: BCBS MT Traditional |
$70.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$66.50
|
| Rate for Payer: Cigna Medicare |
$63.00
|
| Rate for Payer: Medicaid All Medicaid |
$64.40
|
| Rate for Payer: Medicare All Medicare |
$49.00
|
| Rate for Payer: Monida Allegiance |
$66.50
|
| Rate for Payer: Monida First Choice Health |
$67.90
|
| Rate for Payer: Monida Montana Health Co-op |
$66.50
|
| Rate for Payer: Monida PacificSource |
$66.50
|
|
|
CALIBRATOR, ANEMIA
|
Facility
|
IP
|
$70.00
|
|
| Hospital Charge Code |
90197099
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna Commercial |
$66.50
|
| Rate for Payer: Aetna Medicare |
$63.00
|
| Rate for Payer: BCBS MT CHIP |
$63.00
|
| Rate for Payer: BCBS MT Closed Plan Network |
$66.50
|
| Rate for Payer: BCBS MT HealthLink |
$63.00
|
| Rate for Payer: BCBS MT Medicare |
$63.00
|
| Rate for Payer: BCBS MT POS |
$66.50
|
| Rate for Payer: BCBS MT Traditional |
$70.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$66.50
|
| Rate for Payer: Cigna Medicare |
$63.00
|
| Rate for Payer: Medicaid All Medicaid |
$64.40
|
| Rate for Payer: Medicare All Medicare |
$49.00
|
| Rate for Payer: Monida Allegiance |
$66.50
|
| Rate for Payer: Monida First Choice Health |
$67.90
|
| Rate for Payer: Monida Montana Health Co-op |
$66.50
|
| Rate for Payer: Monida PacificSource |
$66.50
|
|
|
CALIBRATOR, FERRITIN
|
Facility
|
OP
|
$45.00
|
|
| Hospital Charge Code |
90197105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$42.75
|
| Rate for Payer: Aetna Medicare |
$40.50
|
| Rate for Payer: BCBS MT CHIP |
$40.50
|
| Rate for Payer: BCBS MT Closed Plan Network |
$42.75
|
| Rate for Payer: BCBS MT HealthLink |
$40.50
|
| Rate for Payer: BCBS MT Medicare |
$40.50
|
| Rate for Payer: BCBS MT POS |
$42.75
|
| Rate for Payer: BCBS MT Traditional |
$45.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$42.75
|
| Rate for Payer: Cigna Medicare |
$40.50
|
| Rate for Payer: Medicaid All Medicaid |
$41.40
|
| Rate for Payer: Medicare All Medicare |
$31.50
|
| Rate for Payer: Monida Allegiance |
$42.75
|
| Rate for Payer: Monida First Choice Health |
$43.65
|
| Rate for Payer: Monida Montana Health Co-op |
$42.75
|
| Rate for Payer: Monida PacificSource |
$42.75
|
|
|
CALIBRATOR, FERRITIN
|
Facility
|
IP
|
$45.00
|
|
| Hospital Charge Code |
90197105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$42.75
|
| Rate for Payer: Aetna Medicare |
$40.50
|
| Rate for Payer: BCBS MT CHIP |
$40.50
|
| Rate for Payer: BCBS MT Closed Plan Network |
$42.75
|
| Rate for Payer: BCBS MT HealthLink |
$40.50
|
| Rate for Payer: BCBS MT Medicare |
$40.50
|
| Rate for Payer: BCBS MT POS |
$42.75
|
| Rate for Payer: BCBS MT Traditional |
$45.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$42.75
|
| Rate for Payer: Cigna Medicare |
$40.50
|
| Rate for Payer: Medicaid All Medicaid |
$41.40
|
| Rate for Payer: Medicare All Medicare |
$31.50
|
| Rate for Payer: Monida Allegiance |
$42.75
|
| Rate for Payer: Monida First Choice Health |
$43.65
|
| Rate for Payer: Monida Montana Health Co-op |
$42.75
|
| Rate for Payer: Monida PacificSource |
$42.75
|
|
|
CALIBRATOR, HCG
|
Facility
|
OP
|
$50.32
|
|
| Hospital Charge Code |
90197097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$50.32 |
| Rate for Payer: Aetna Commercial |
$47.80
|
| Rate for Payer: Aetna Medicare |
$45.29
|
| Rate for Payer: BCBS MT CHIP |
$45.29
|
| Rate for Payer: BCBS MT Closed Plan Network |
$47.80
|
| Rate for Payer: BCBS MT HealthLink |
$45.29
|
| Rate for Payer: BCBS MT Medicare |
$45.29
|
| Rate for Payer: BCBS MT POS |
$47.80
|
| Rate for Payer: BCBS MT Traditional |
$50.32
|
| Rate for Payer: Cash Price |
$45.29
|
| Rate for Payer: Cigna Commercial |
$47.80
|
| Rate for Payer: Cigna Medicare |
$45.29
|
| Rate for Payer: Medicaid All Medicaid |
$46.29
|
| Rate for Payer: Medicare All Medicare |
$35.22
|
| Rate for Payer: Monida Allegiance |
$47.80
|
| Rate for Payer: Monida First Choice Health |
$48.81
|
| Rate for Payer: Monida Montana Health Co-op |
$47.80
|
| Rate for Payer: Monida PacificSource |
$47.80
|
|
|
CALIBRATOR, HCG
|
Facility
|
IP
|
$50.32
|
|
| Hospital Charge Code |
90197097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$50.32 |
| Rate for Payer: Aetna Commercial |
$47.80
|
| Rate for Payer: Aetna Medicare |
$45.29
|
| Rate for Payer: BCBS MT CHIP |
$45.29
|
| Rate for Payer: BCBS MT Closed Plan Network |
$47.80
|
| Rate for Payer: BCBS MT HealthLink |
$45.29
|
| Rate for Payer: BCBS MT Medicare |
$45.29
|
| Rate for Payer: BCBS MT POS |
$47.80
|
| Rate for Payer: BCBS MT Traditional |
$50.32
|
| Rate for Payer: Cash Price |
$45.29
|
| Rate for Payer: Cigna Commercial |
$47.80
|
| Rate for Payer: Cigna Medicare |
$45.29
|
| Rate for Payer: Medicaid All Medicaid |
$46.29
|
| Rate for Payer: Medicare All Medicare |
$35.22
|
| Rate for Payer: Monida Allegiance |
$47.80
|
| Rate for Payer: Monida First Choice Health |
$48.81
|
| Rate for Payer: Monida Montana Health Co-op |
$47.80
|
| Rate for Payer: Monida PacificSource |
$47.80
|
|
|
CALIBRATOR, IRON
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
90197103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial |
$33.25
|
| Rate for Payer: Aetna Medicare |
$31.50
|
| Rate for Payer: BCBS MT CHIP |
$31.50
|
| Rate for Payer: BCBS MT Closed Plan Network |
$33.25
|
| Rate for Payer: BCBS MT HealthLink |
$31.50
|
| Rate for Payer: BCBS MT Medicare |
$31.50
|
| Rate for Payer: BCBS MT POS |
$33.25
|
| Rate for Payer: BCBS MT Traditional |
$35.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$33.25
|
| Rate for Payer: Cigna Medicare |
$31.50
|
| Rate for Payer: Medicaid All Medicaid |
$32.20
|
| Rate for Payer: Medicare All Medicare |
$24.50
|
| Rate for Payer: Monida Allegiance |
$33.25
|
| Rate for Payer: Monida First Choice Health |
$33.95
|
| Rate for Payer: Monida Montana Health Co-op |
$33.25
|
| Rate for Payer: Monida PacificSource |
$33.25
|
|
|
CALIBRATOR, IRON
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
90197103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial |
$33.25
|
| Rate for Payer: Aetna Medicare |
$31.50
|
| Rate for Payer: BCBS MT CHIP |
$31.50
|
| Rate for Payer: BCBS MT Closed Plan Network |
$33.25
|
| Rate for Payer: BCBS MT HealthLink |
$31.50
|
| Rate for Payer: BCBS MT Medicare |
$31.50
|
| Rate for Payer: BCBS MT POS |
$33.25
|
| Rate for Payer: BCBS MT Traditional |
$35.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$33.25
|
| Rate for Payer: Cigna Medicare |
$31.50
|
| Rate for Payer: Medicaid All Medicaid |
$32.20
|
| Rate for Payer: Medicare All Medicare |
$24.50
|
| Rate for Payer: Monida Allegiance |
$33.25
|
| Rate for Payer: Monida First Choice Health |
$33.95
|
| Rate for Payer: Monida Montana Health Co-op |
$33.25
|
| Rate for Payer: Monida PacificSource |
$33.25
|
|
|
CALIBRATOR, PROCALCITONIN
|
Facility
|
OP
|
$97.42
|
|
| Hospital Charge Code |
90197092
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.19 |
| Max. Negotiated Rate |
$97.42 |
| Rate for Payer: Aetna Commercial |
$92.55
|
| Rate for Payer: Aetna Medicare |
$87.68
|
| Rate for Payer: BCBS MT CHIP |
$87.68
|
| Rate for Payer: BCBS MT Closed Plan Network |
$92.55
|
| Rate for Payer: BCBS MT HealthLink |
$87.68
|
| Rate for Payer: BCBS MT Medicare |
$87.68
|
| Rate for Payer: BCBS MT POS |
$92.55
|
| Rate for Payer: BCBS MT Traditional |
$97.42
|
| Rate for Payer: Cash Price |
$87.68
|
| Rate for Payer: Cigna Commercial |
$92.55
|
| Rate for Payer: Cigna Medicare |
$87.68
|
| Rate for Payer: Medicaid All Medicaid |
$89.63
|
| Rate for Payer: Medicare All Medicare |
$68.19
|
| Rate for Payer: Monida Allegiance |
$92.55
|
| Rate for Payer: Monida First Choice Health |
$94.50
|
| Rate for Payer: Monida Montana Health Co-op |
$92.55
|
| Rate for Payer: Monida PacificSource |
$92.55
|
|
